Provider Demographics
NPI:1740216985
Name:MAINWARING, MARK G (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:G
Last Name:MAINWARING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 440100
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37244-0100
Mailing Address - Country:US
Mailing Address - Phone:615-329-0570
Mailing Address - Fax:
Practice Address - Street 1:1840 MEDICAL CENTER PKWY
Practice Address - Street 2:SUITE 300
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-2564
Practice Address - Country:US
Practice Address - Phone:615-848-0488
Practice Address - Fax:615-904-9061
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN35429207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3865363Medicaid
7814241OtherAETNA
3640237OtherUNITED HEALTHCARE
900003716OtherRAILROAD MEDICARE
4015906OtherBCBS OF TN
KY64036239Medicaid
3865363Medicare ID - Type UnspecifiedMEDICARE
TN3865363Medicaid